Tsunoda Akira, Maruki Chikashi
Department of Neurosurgery, Koshigaya Municipal Hospital, Saitama, Japan.
Neurol Med Chir (Tokyo). 2007 Sep;47(9):403-8; discussion 408. doi: 10.2176/nmc.47.403.
The dual switch valve (DSV), which switches between two parallel valve chambers depending on the patient posture, was evaluated in 101 consecutive adult patients with hydrocephalus who required shunt surgery. The opening pressure was 5 or 10 cmH(2)O for the supine position and 30 or 40 cmH(2)O for the upright position depending on the sitting height. The results clearly showed that the DSV can regulate the intraventricular pressure (IVP) to 5 to 10 cmH(2)O in the supine and almost zero in the upright position, independently of posture. Ninety-four of the 101 patients received the DSV and 86 patients showed some clinical improvement. However, three patients required irrigation of subdural hematoma and six were thought to suffer underdrainage (4 probable and 2 possible). Such underdrainage probably resulted from the relatively high opening pressure in the supine position of 10 cmH(2)O and the bedridden state of these patients. This problem may be solved by the DSV with the 5 cmH(2)O setting in the supine position. The DSV can maintain physiological IVP in hydrocephalic patients independently of posture and provides generally satisfactory clinical outcome, but cannot prevent all inadequate drainage-related problems.
双开关阀（DSV）可根据患者体位在两个平行的阀腔之间切换，对101例连续需要分流手术的成年脑积水患者进行了评估。根据坐高，仰卧位时开启压力为5或10 cmH₂O，直立位时为30或40 cmH₂O。结果清楚地表明，DSV可将仰卧位时的脑室内压（IVP）调节至5至10 cmH₂O，直立位时几乎为零，且与体位无关。101例患者中有94例接受了DSV，86例患者有一定临床改善。然而，3例患者需要冲洗硬膜下血肿，6例被认为存在引流不足（4例可能，2例可能）。这种引流不足可能是由于仰卧位时10 cmH₂O的相对较高开启压力以及这些患者的卧床状态所致。仰卧位设置为5 cmH₂O的DSV可能解决此问题。DSV可在脑积水患者中独立于体位维持生理IVP，并提供总体令人满意的临床结果，但不能预防所有与引流不足相关的问题。
